Utilization Review Nurse
2 months ago
**Position Title: Utilization Review Nurse - Workers’ Compensation**
**Hours: 40 hours/week. This is a salaried, exempt position.**
**Location: Manchester, NH**
**Overview**
Windham Group’s mission is to return injured workers to health while maintaining productivity at their original jobs. Our Credo, _“To work is to be needed, and to be needed is essential for life”_is what drives us. We work as a team to integrate expertise at every level of recovery to restore the health, well-being and livelihood to the injured and disabled, thereby reducing the financial and human costs of work related injuries.
Due to consistent growth, Windham Group is seeking a full time **Utilization Review Nurse **in our Manchester, NH office.
**Job Description - Utilization Review Nurse**
This is a full-time position that reviews requested medical treatment, matches it to guidelines mandated by the DIA OHP, and comes to a decision regarding medical necessity
**Essential Duties and Responsibilities**
- Perform state mandated utilization review (review of medical care) and makes decisions regarding medical necessity and quality of care based on state guidelines.
- Review medical documentation and summarize findings by following regulations and outlined procedures
- Approve medically necessary services to promote quality care. Assist in determination of medically complicated treatment authorization requests. Review, document and summarize findings.
**Requirements**:
- Knowledge of professional nursing principles and techniques, medical terminology; hospital routine and equipment; and medicines and narcotics
- Position requires extensive computer use requiring computer knowledge in MS Outlook, Word and Adobe.
- Critical thinking
- Strong communication skills both verbal and written.
- Demonstrate strong assessment skills and attention to detail
- Must be able to demonstrate team behavior and must be willing to promote a team-oriented environment
- Ability to multi-task
- Time management skills
- Ability to work independently
- Utilization Review experience, preferably with workers comp
- Graduate of an accredited school of nursing.
- RN, with a Bachelors degree in a health related field a plus
- Three years of professional nursing
- Experience in an institution licensed for inpatient care
- Current license as a Registered Nurse in the state of New Hampshire
- MUST have excellent computer skills
**Reports to**:Director of Utilization Review
**Salary Structure**:Commensurate with experience and qualifications
**Benefits**:
- 401(k)
- 401(k) matching
- Dental insurance
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- Monday to Friday
**Education**:
- Associate (preferred)
**Experience**:
- Utilization review: 1 year (preferred)
- Workers Compensation: 1 year (preferred)
License/Certification:
- RN (preferred)
Work Location: In person
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